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Accumulator - View By Claim

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Health Center:
Pharmacy:
Capture Date :
To:


Health
Center
Pharmacy
ShipTo
Claim
Type
RX
Number
Member ID
Fill
Fill Date
Adjud
Date
Captured
Date
NDC
Drug
Name
Strength
Form
Pkg
Size
QTY
Disp
Curr
QTY
% of
Claim
Status
Status
Date
Order
Wholesaler
Invoice
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793927 MR002184180011/01/202211/01/202211/02/202200173089310TRELEGY ELLIPTA 200-62.5-25200-62.5DISK W/DEV606060100.00000Replenished 1002128232 3111347420
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794683 MR002184180012/14/202212/14/202212/15/202200173089310TRELEGY ELLIPTA 200-62.5-25200-62.5DISK W/DEV606060100.00000Replenished 1002150356 3116568459
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794683 MR002184180102/02/202302/02/202302/03/202300173089310TRELEGY ELLIPTA 200-62.5-25200-62.5DISK W/DEV606060100.00000Replenished 1002170585 3122206860